Blepharoplasty (Eyelid Surgery)

Your Eyelids

Your eyes are an important focus of your face. People looking at your face look first at your eyes and nose. If you have beautiful eyes, their gaze may stay right there. Unfortunately, if your eyes look tired, their gaze may also stay there.

You may feel younger than your age, but your eyes may make you look tired all the time and betray your age.

What you can do

The dark shadows of your lower eyelids may be due a number of factors: increased dark pigment in your lower lids, shadows from the fat in your lids, or a combination of both. The normal movement of the muscles around the eyes and sun exposure causes lower lid wrinkles. We offer a number of quick non-invasive home and office treatments that may help your eyelid area:

GLO mineral makeup can hide some imperfections.

ZO Skin Care® can lighten and tighten the skin.

A small amount of botulinum toxin like Botox, Dysport or Xeomin can decrease crow’s feet wrinkles and thickened muscles in the lower eyelid or help lift the brow.

A hyaluronic acid filler like Belotero Balance, Restylane or Juverderm can fill tear troughs, the depression in your lower lid that shows off early bags.

We also offer non-invasive and minimally invasive procedures that can rejuvenate the lower eyelids by stimulating new collagen formation in the skin:

Pellevé is a non-invasive bipolar radiofrequency treatment that can tighten the lower eyelids, decrease wrinkles and add volume to hollow areas. It is done by our expertly trained aestheticians, is virtually painless, and can be a part of your maintenance routine.

Portrait Portrait PSR3Plasma and UltraPulse® Carbon Dioxide Laser resurfacing are minimally invasive. They help create new skin formation, go deeper into the skin, can lighten and tighten the skin and eliminate even more wrinkles. The laser penetrates deeper that plasma. Bentkover will council you on which he thinks will work best in your particular situation.

Some of us will need surgery…

Blepharoplasty (Eyelid Surgery)

A Blepharoplasty is often the first aesthetic procedure requested in middle age, commonly around age 40-43.

Your genetics and sun exposure contribute to how your eyelids age. For that reason, your eyelid surgery should be customized to your needs.

An upper eyelid blepharoplasty is essentially a removal of excess skin to re-create the upper eyelid crease. A small amount of fat and muscle may also be removed or tightened. Because loss of volume is a major factor in aging, we often prefer to tighten the membrane that holds the fat in place instead of removing fat. This repositions the fat that has been there your whole life so it no longer protrudes so much. If your brow has become much lower with age, an upper eyelid blepharoplasty may be combined with an open or endoscopic brow lift at the same time or in a prior operation. Or, perhaps you need just a browift. We commonly do upper eyelid blepharoplasty alone under local anesthesia our office operating room. This reduces the cost of the procedure.

A lower eyelid blepharoplasty may flatten the lower eyelid or plump the lower eyelid, depending on what you need. This is done through a transconjunctival approach just inside the eyelid or an incision under the lashes. A lower eyelid blepharoplasty can be as straight forward as a conservative reduction in the amount of protruding fat (the “bags”) in the lower eyelid. In patients with significant hollow areas in the lower eyelid, tear troughs, Dr. Bentkover may instead choose to move protruding fat from the eyelid into the tear trough (fat transposition blepharoplasty) or lift some fat of the upper cheek to the eyelid (a SOOF lift). To tighten the skin and reduce eyelid and crow’s feet wrinkles, he often resurfaces the lower eyelid and crow’s feet area with the Ultra Pulse® Carbon Dioxide Laser or Portrait PSR3 Plasma Skin Resurfacing at the time of the surgery. He may recommend follow up with Pellevé for long term maintenance. A lower eyelid blepharoplasty usually requires intravenous sedation or a brief general anesthesia.

Insurance

If the skin of your upper eyelid is so excessive that it significantly obstructs your vision, your insurance company may pay for part or all of the cost of an upper eyelid blepharoplasty. Insurance companies and Medicare have specific criteria for covering this surgery based on a test done by an ophthalmologist called a visual field test. If you think your upper eyelids impair your vision, you should have a visual field test performed in an ophthalmologist’s office prior to your consultation. Bring a copy with you to the consultation.

What can I expect during Recovery?

The area surrounding the eyes will remain swollen in the days following the surgery. Ice will be your friend. With conscientious application of ice packs, it should begin to subside after the second or third day. Some temporary blurring of vision is normal. Sutures are necessary and usually dissolve in a week.

UPPER LIDS: Noticeable swelling and bruising will persist for about 10 – 14 days and can extend to the lower lids. Usually you can begin wearing makeup in 2 weeks. Activity precautions are designed to prevent bleeding. You can go for walks or get on a slow treadmill or elliptical machine at 10 days. You may resume strenuous exercise in about 3 weeks. You can start enjoying your new look within approximately 21 days. It may take about 6 months for the upper lid scars to fade to their final appearance and can take up to 3 months for slight to moderate residual swelling to subside.

LOWER LIDS: With fat transposition blepharoplasty, you may have some sutures that go through the skin of the lower eyelid to the fat below and back out. These sutures initially hold the fat in place for 7 days. They are taped to the skin or tied over a piece of Telfa®. Swelling and bruising with any technique that can take 3 weeks to clear. Activity precautions are the same as for upper lid surgery (above).

Complications are uncommon but can occur with any surgery. Complications may include bleeding, excessive swelling, delayed wound-healing, infection, drooping of the upper or lower eyelid, asymmetry, double vision and dry eyes. Yes, blindness is a risk of eyelid surgery, an extremely rare complication of any eyelid operation done by any surgeon. It is generally related to excessive bleeding.

FAQS

Not much. Normal face washing and remove all makeup. Our staff or the hospital staff will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, and medications. If you smoke, we will ask you to quit for at least two weeks before and after your surgery, since smoking may have an effect on how well you heal. You must stop all anticoagulant medications or herbal preparations such as aspirin, ibuprofen, naproxen, vitamin E, St. John’s Wort, gingko, garlic or ginseng 10 days prior to surgery. You may be required to take antibiotics to prevent infection. We will give you prescriptions for antibiotic eye ointment and pain medication.

Before a blepharoplasty, Dr. Bentkover may mark your upper eyelids with a temporary marker. For the upper eyelid, an incision is made in the natural crease of the upper lid. For the lower eyelid, the incision is just inside the eyelid or just under the lashes. Once healed, these incisions are usually minimally noticeable.

No. If you have a condition called ptosis, the upper eyelid actually sits too low. If may be obstructing your pupil. The lid can be tightened to lift it above your pupil and iris. This is generally a functional procedure and may be combined with an upper eyelid blepharoplasty.

Dr. Bentkover rarely removes skin from the lower eyelids. A skin removal can lead to scar that can pull the eyelid downward. He usually uses a carbon dioxide laser or plasma skin resurfacing to tighten the eyelid.

The tear trough is a depression of the lower eyelid that angles from the nose to the cheek. It is also called the nasal jugal groove. It is thought to be the result of thinning and downward movement of the fat in the upper cheek and the natural pull of the folds of the eyelid muscle called the obicularis oculi. As the fat of the lower eyelid above it pushes forward with age, it also makes it looks worse. Often just decreasing the amount of fat above it will hollow out the eyelid more. Using that fat to fill the tear trough (fat transposition) seems to re-create a more natural convexity of the eyelid, restoring some of the youthful flow of the contour of the lower eyelid into the upper cheek. If you have early tear trough formation and little or no fat protrusion, a hyaluronic acid filler may be a good temporary fix; for safety reasons, it should be performed only by a board certified physician who does surgery of the eyelids.

You need a consultation to determine this. In most cases, patients who want a lower eyelid blepharoplasty look better if some protruding fat of the lower eye (the “bags” – called pseudo fat herniation) is moved into the tear trough.

Fortunately, these operations seem to have very good longevity. While everyone ages at a different rate blepharoplasty seems to persist for many years. Other than for early touch ups, I have rarely had to repeat the procedure before 10-15 years.

Upper lids, very little usually. Lower lids, some tightness and minimal pain with eye movement for a few days. We will give you appropriate prescriptions. Many patients just take acetaminophen after the first day.

Upper eyelids of a non-smoker: You can expect significant noticeable swelling for 14 days or so. It will take about 3 months for all of the swelling to slowly disappear, but generally other people will not notice your swelling after 14 days. Lower eyelids of a non-smoker: about 14 days for a straight forward procedure that just reduces fat. Swelling with fat transposition or the SOOF lift is noticeable for 3-6 weeks. Any residual swelling after this is usually noticeable only to you and will take 3 months or so to resolve.

If you have very loose lower eyelids, Dr. Bentkover may need to tighten the lower lids prior to or at the time of blepharoplasty or resurfacing. Such a procedure may be called a canthoplasty or canthal suspension.